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Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: Recommendations From the U.S. Preventive Services Task ForceFREE

The full report is titled “Screening for Suicide Risk in Adolescents, Adults, and Older Adults in Primary Care: U.S. Preventive Services Task Force Recommen-dation Statement.” It is in the 20 May 2014 issue of Annals of Internal Medicine (volume 160, pages 719-726). The author is M.L. LeFevre, on behalf of the U.S. Preventive Services Task Force.

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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Suicide (intentionally killing oneself) was the 10th most common cause of death in the United States in 2010. Suicide is most common in adolescence and old age. People who have psychiatric disorders, such as depression, or drug or alcohol abuse or who have previously tried to kill themselves are more likely to die by suicide than those who do not have any of these conditions. Because many patients who die by suicide have been seen in a primary care setting within the year before suicide, some experts have wondered whether suicide could be reduced by screening primary care patients for suicide risk and offering suicide prevention treatments to those identified as being at risk. Screening means looking for a condition in people who do not have any outward signs or symptoms of the condition. However, in 2004, the USPSTF could recommend neither for nor against screening for suicide as part of routine primary care because there were too few studies of the benefits and harms of screening for suicide. The USPSTF wanted to update these recommendations on the basis of studies that have become available since then.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research about the benefits and harms of screening for suicide risk. The review included research about the benefits and harms of strategies to identify people at risk for suicide and of treatments to prevent suicide in those found to be at risk.

What did the authors find?

Although screening questionnaires about suicide risk exist, they have been studied primarily in mental health settings. The accuracy of these questionnaires in identifying general primary care patients who do not have a history of mental health problems and are at risk for suicide is unknown. The authors also found few studies showing that treating people who screen positive for suicide risk reduces suicides or suicide attempts. Most studies of the effectiveness of treatments to prevent suicide have been in people with mental health conditions rather than those identified through screening. Furthermore, no existing studies found conclusive evidence addressing the potential harms of screening for suicide.

What does the USPSTF recommend that patients and doctors do?

The USPSTF concludes that there is not enough evidence to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults during primary care visits.

What are the cautions related to these recommendations?

These recommendations apply to primary care patients without known psychiatric conditions. Given that most people who die by suicide have a psychiatric disorder, primary care clinicians should be aware of psychiatric problems in their patients and should consider asking these patients whether they have considered suicide and refer them for mental health care.

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